Foreign bodies and even contact lenses are often lodged under the upper eyelid or in the conjunctival fornix of the upper eyelid. A common procedure conducted by eye-care professionals to remove a foreign body lodged in the upper eyelid is an upper eyelid eversion. An eyelid eversion is the turning of an eyelid inside out so as to expose the palpebral conjunctiva. An upper eyelid eversion is accomplished by grasping the lid by the central eyelashes, pulling it downward and forward and then folding it back over a cotton applicator (or thin plastic rod) placed at the upper margin of the tarsus, while the patient continually maintains downward fixation. With the upper eyelid everted, the eye-care professional can more easily access and remove the foreign body. The eyelid is returned to the normal lid position by asking the patient to look up and gently pushing the eyelashes in an outward and downward direction. Eversion of the lower eyelid is performed by drawing the margin of the tarsus downward while the patient looks upward.
Occasionally a foreign body is lodged so far up in the upper eyelid that an eversion of the upper eyelid is not sufficient to see and/or remove the foreign body. In such situations, a double eyelid eversion is required. A double eyelid eversion is an eyelid eversion followed by the turning of the tarsus skin surface of the eyelid inside out such that the fornix skin surface of the eyelid is exposed (in order to make the patient more comfortable, a double eversion is sometimes accompanied by local anesthesia of the conjunctiva). A double eyelid eversion is often carried out using a medical instrument called a Desmarres refractor (a Desmarres retractor is an elongated handheld medical instrument that has a smoothly curved or saddle-shaped spoon-like hook member at one end; see FIG. 1). With the eyelid everted, the hook member of a Desmarres retractor is placed between the two skin surfaces of the eyelid such that the retractor engages the tarsus, and then the tarsus is gently pulled outward and upward until the fornix becomes visible.
Since the longitudinal dimension of a Desmarres retractor generally comes out from the patient's eye toward the eye-care professional during use, it can be extremely difficult to use a Desmarres retractor (to perform, for example, a double eyelid eversion) while also using a bio-microscope (e.g., a slit lamp) to identify the foreign body lodged in the eyelid.
Another fairly common instrument used to perform a double eyelid eversion is a scleral depressor, which is basically an elongated piece of metal with a single paddle at the end. Scleral depressors do not work well for performing double eyelid eversions because the single paddle at the end of the depressor does not hook onto the eyelid very effectively, and scleral depressors, like Desmarres retractors, are hard to use in the minimal space available when using a slit lamp.
U.S. Pat. No. 4,453,546 to Norman N. K. Katz et al. (hereinafter, “Katz et al.”), titled “Scleral depressor”, issued Jun. 12, 1984, and is incorporated herein by reference. Katz et al. describe an ophthalmic instrument for controlling eye position comprising a substantially oblong shaped blade that has a textured surface and that is formed with a hole substantially in the middle of the blade. In operation, the blade is manipulated by the operator to depress against the sclera of a patient's eye for either rotating or immobilizing the globe of the eye during examination. The instrument further comprises a handle, with optional pocket clip, which is attached to the blade at an offset angle to facilitate manipulation of the blade from a position that leaves the field substantially clear for the simultaneous use of other instruments, such as an ophthalmoscope.
U.S. Patent Application Publication US 2008/0081952 to Robert G. Josephberg (hereinafter, “Josephberg”), titled “SCLERAL DEPRESSOR”, published Apr. 3, 2008, and is incorporated herein by reference. Josephberg describe a scleral depressor designed to better control the globe of the eye is disclosed. In a preferred embodiment, the scleral depressor has a handle and a blade attached to the handle where the blade is a portion of an oblate spheroid. In one embodiment, the blade has an illuminating device. The handle is attached to the blade at an angle or straight in relation to the plane of the handle. In another embodiment, the blade is attached to a thimble. In another embodiment of the invention, the blade has an access hole for simultaneous use of other instruments during examination or surgery. The resulting apparatus has greatly improved control of the eye, effective visualization of the periphery, ease of use for the examiner, and increased comfort for the patient.
There is a need for an improved apparatus and method for performing a double eyelid eversion, particularly a double eyelid eversion that can be performed while the patient is in front of a slit lamp during the search and removal of a foreign body from the upper eyelid of the patient.